Active NPI
Peter Allen Rust, PA-C
- Physician Assistant
- Middleburg, FL
National Provider Identifier
1477690956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9102776
- Practice address
- 3360 County Road 220
Middleburg, FL 32068 - Phone
- (904) 291-2221
- Fax
- (904) 291-2261
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9102776 | FL | Primary |
Addresses
Primary practice location
3360 County Road 220
Middleburg, FL 32068
Mailing address
2503 Elbow Rd
Orange Park, FL 32073-5504
Phone (904) 504-6773
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9102776 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449792000000",
"number": "1477690956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2503 ELBOW RD",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320735504",
"telephone_number": "904-504-6773",
"fax_number": "904-291-2261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3360 COUNTY ROAD 220",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "32068",
"telephone_number": "904-291-2221",
"fax_number": "904-291-2261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUST",
"first_name": "PETER",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2015-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9102776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.